Face transplant for 'zombie' victim? First comes simple survival

"Zombie apocalypse," voodoo curses and a potent street drug called "bath salts." Those are just a few of the angles the media have pursued after the bizarre case of a naked man shot and killed by Miami police as he was eating the face of another man.

A less sensational angle? The long, sad journey that awaits the homeless victim, Ronald Poppo, 65, who is believed to have lost about 80% of his face -- including one eye -- in the gruesome daylight attack.

Poppo is not likely to get a face transplant, experts say. Such procedures are extremely rare. Far more likely for Poppo is facial reconstruction using his body's tissues, a process that is likely to involve many, many surgeries.

Poppo was attacked on May 26 by Rudy Eugene, 31, who was naked and gnawed on the helpless man's face for nearly 20 minutes. No one knows what propelled Eugene. His girlfriend told the media she wondered whether he had been subjected to a voodoo curse. There has been some speculation, not confirmed by police. that he might have been under the influence of a street drug dubbed bath salts. Still others are talking "zombie apocalypse."

The cost of Poppo's medical care is likely to run into the hundreds of thousands of dollars -- or more. One organization has raised more than $9,000 to help defray costs.

However, neither he nor any other patient in a similar circumstance would be charged for the cost of face transplant surgery because it is considered experimental, and would be covered by research-related grants, said Dr. Daniel Alam of the American Academy of Facial Plastic and Reconstructive Surgery.

But such matters are far in the future for Poppo. Doctors at Jackson Memorial Hospital's Ryder Trauma Center in Miami mostly likely are focused solely on the day-to-day work of keeping him alive.

Alam is not treating Poppo. But he is well-versed in the steps that physicians must take in the days and weeks after taking on such a medically fragile case. Alam has performed 600 facial reconstructive surgeries and two face transplants, including the well-known case of the Connecticut woman savaged by a chimpanzee.

"Right now, they are just concerning themselves with the things necessary to stabilize him," Alam told the Los Angeles Times. "It's just about keeping him alive."

Only after Poppo is stabilized can doctors even begin to consider what steps to take next, he said.

The physicians treating him will have to consider some uncomfortable issues: What kind of personal support system awaits the man who was living on Miami's sidewalks and will now likely need specialty medical care for the rest of his life?

"You have to be a very, very diligent patient for the rest of your life," he said.

Take one simple indicator: Is Poppo someone who can be counted upon to make all doctor's appointments, and take his medicine regularly, and as prescribed?

"Then, you begin to then consider what reconstructive options you have," Alam said. "That depends on what kind of native tissue remains."

The extent of Poppo's injuries have not been specified by his doctors. But Sgt. Armando Aguilar, president of the Miami Fraternal Order of Police, was quoted as saying in the local media: "He had his face eaten down to his goatee. The forehead was just bone. No nose, no mouth."

Alma said that experts can typically take skin, cartilage and bone from other parts of the body and transplant it to the face to help mimic cheeks, a nose or a jawbone. "But when you start missing your eyelids and your eyes, and the parts of the face that you use for smiling, like your mouth, that makes it much more difficult," he said.

Improvements must be done in stages over the course of multiple surgeries.

"I think there is a perception in the media that he is going to get a face transplant next week," Alma said. "It doesn't work like that."

He said Charla Nash, the woman attacked by the chimp, waited longer than two years for her face transplant.

"If this person is a candidate for a face transplant at some point in the future, there is still a very long road ahead for everybody," he said.